Provider Demographics
NPI:1225806961
Name:KINDERCARE BEHAVIORAL HEALTH AND SERVICES
Entity Type:Organization
Organization Name:KINDERCARE BEHAVIORAL HEALTH AND SERVICES
Other - Org Name:KINDERCARE BEHAVIORAL HEALTH AND SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOWUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:936-668-1479
Mailing Address - Street 1:704 LONGMIRE RD STE 243
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1850
Mailing Address - Country:US
Mailing Address - Phone:936-668-1479
Mailing Address - Fax:
Practice Address - Street 1:704 LONGMIRE RD STE 243
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1850
Practice Address - Country:US
Practice Address - Phone:936-668-1479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty